This Letter to the Editor is yet another example of presumably-intelligent individuals who accidentally MISINTERPRETED clinical study findings  OR, who purposefully elected to MISREPRESENT them. And, as is usual in such cases, weird (suspicious) stuff is associated with this letter.

(1)One of the letter's two authors, Steven B. Karch (a pathologist with the San Francisco Medical Examiner's office), also appears to be among the co-authors of both the NAME position paper and the Criteria for the Interpretation of Cocaine Levels review. Consequently, the Glatter/Karch letter complains about guidelines that Karch helped to develop  guidelines that he agreed to have his name associated with.

(2)Why did Glatter and Karch send their letter to the editor of a journal that doesn't appear to EVER have published an article about restraint asphyxia deaths  with or without a relationship to cocaine intoxication? Why didn't Glatter and Karch send their letter to the editor of the journal that published the position paper they complained about?Ah. Perhaps they DID send it to the Am J Forensic Med Pathol editor, but their letter was denied publication. If so, why was their letter denied publication? It's certainly not because that journal won't publish letters containing "criticism." After all, it published Allegheny County Coroner, Cyril H. Wecht's Response to the NAME position paper  a letter identifying "a serious and significant omission in the committee's overall discussion and specific recommendations." So, was the Glatter/Karch letter refused publication because it was without MERIT?

Clearly, both these "weird (suspicious) points" are entirely unimportant to an evaluation of the letter's content. But, both points are TRUE, thus they are something for consideration.

BOTTOM LINE:
This letter's authors ultimately promote the truly ridiculous suggestion that "genetic abnormality" is the "most obvious" cause of deaths that occur during the application of forceful-prone-restraint. Yet, the "support" these authors offer for their ridiculous suggestion consists entirely of erroneous interpretations of controlled clinical studies performed using healthy individuals subjected to forms of restraint that do not  in any way  represent realistic restraint situations.In fact, the authors' "most obvious" cause of death suggestion is so ridiculous, and their letter so full of study-findings-misinterpretations (-MISREPRESENTATIONS), that one cannot help but conclude that Glatter and Karch must have some sort of "personal interest" in exonerating restrainers from responsibility for having caused someone's death. Unfortunately, this is not an unusual occurrence. But, thankfully, this is NOT the MOST PREVALENT attitude of Medical Examiners across the country!In the incredibly wise, honest, and UNBIASED words of Allegheny County Coroner, Cyril H. Wecht:

"...the adamant refusal of some of our colleagues to even consider police misconduct and brutality as the underlying feature of such cases is most regrettable and, in my opinion, morally and ethically indefensible."